Awake off-pump coronary artery bypass grafting: our experiences of 14 cases

Background: In this study, we defined our experiences on the feasibility and efficacy of high-thoracic epidural anesthesia + femoral block in 14 conscious patients undergoing offpump coronary artery bypass grafting (OPCAB) with median sternotomy. Methods: Fourteen conscious patients (8 males, 6 females; mean age: 57.6±9.4 years; range 48 to 67 years) with symptomatic coronary artery disease who were scheduled for OPCAB were included. An epidural catheter was inserted from the intervertebral spaces T1-2 or T2-3 one day prior to surgery. In the operating room, 5 mL of epidural solution (15 mL of lidocaine 2%, 2 mL of bicarbonate, fentanyl 100 mg and epinephrine 100 mg in 20 mL solution) was administered at five-minute intervals until the T1-8 dermatome block was obtained. A femoral block was performed on the right and left lower limbs of the patients. The bolus doses of the epidural solution were repeated at 5 mL per hour. The patients were taken to the intensive care unit following the operation. The patients without any problems during the intensive care unit follow-up were taken to the ward. Results: The mean surgical duration, length of intensive care unit stay, and duration of hospitalization were 112.7±25.9 minutes, 9.7±5.4 hours and 3.8±0.8 days, respectively. None of the patients suffered from pain during incision, sternotomy, and sternal retraction as well as throughout the operation. Hypotension was observed in two patients during the operation. The pleura were opened in two patients. General anesthesia was switched in four patients due to various reasons. Conclusion: The combination of high-thoracic epidural anesthesia with femoral block may be an alternative to general anesthesia during OPCAB in selected patients.